中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (33): 7130-7136.doi: 10.12307/2025.861

• 数字化骨科 digital orthopedics • 上一篇    下一篇

3D打印精确化截骨导板在胫骨平台后倾角异常增大的前交叉韧带翻修中的应用

魏志亨1，2，关天民1，刘  青1，弓  爵2，向先祥2   

  1. 1大连交通大学机械工程学院，辽宁省大连市   116028；2大连大学附属新华医院，辽宁省大连市   116021
  • 收稿日期:2024-09-27 接受日期:2024-11-28 出版日期:2025-11-28 发布日期:2025-04-12
  • 通讯作者: 关天民，博士，大连交通大学机械工程学院，辽宁省大连市 116028
  • 作者简介:魏志亨，男，1992年生，辽宁省大连市人，汉族，在读博士，主治医师，主要从事骨科及医工交叉学科的研究。 刘青，女，1999年生，汉族，河北省人，大连交通大学在读硕士，主要从事医疗器械专业方面的研究。

Application of 3D printing accurate osteotomy guide combined with the revision of anterior cruciate ligament with abnormally increased posterior slope of tibial plateau

Wei Zhiheng1, 2, Guan Tianmin1, Liu Qing1, Gong Jue2, Xiang Xianxiang2   

  1. 1School of Mechanical Engineering, Dalian Jiaotong University, Dalian 116028, Liaoning Province, China; 2Xinhua Hospital Affiliated to Dalian University, Dalian 116021, Liaoning Province, China
  • Received:2024-09-27 Accepted:2024-11-28 Online:2025-11-28 Published:2025-04-12
  • Contact: Guan Tianmin, PhD, School of Mechanical Engineering, Dalian Jiaotong University, Dalian 116028, Liaoning Province, China
  • About author:Wei Zhiheng, Doctoral candidate, Attending physician, School of Mechanical Engineering, Dalian Jiaotong University, Dalian 116028, Liaoning Province, China; Xinhua Hospital Affiliated to Dalian University, Dalian 116021, Liaoning Province, China Liu Qing, Master candidate, School of Mechanical Engineering, Dalian Jiaotong University, Dalian 116028, Liaoning Province, China

PDF

51

摘要：


文题释义：

精确化截骨导板：术前采集患者患侧膝关节CT数据(DICOM格式)，后导入Mimics软件，构建膝关节骨骼三维模型。基于三维模型在计算机中设计截骨导板，模拟截骨手术，评估匹配程度，并适度调整，直至理想匹配，之后3D打印截骨导板。
前交叉韧带翻修：针对前交叉韧带初次重建术后移植物非接触性再断裂情况，除需重建前交叉韧带以恢复膝关节稳定性，还需要考虑移植物失效因素，如针对胫骨平台后倾角过大可予以纠正，以巩固手术临床疗效。


背景：胫骨平台后倾角异常增大的前交叉韧带重建术后再断裂患者，行前交叉韧带重建同时联合胫骨前方闭合截骨，但缺少精确化的截骨工具。

目的：探究3D打印精确化截骨导板在胫骨平台后倾角过大的前交叉韧带翻修中的临床疗效。
方法：回顾性收集30例行前交叉韧带翻修联合胫骨前方闭合截骨患者的病历资料，按手术方法分为2组，试验组15例行3D打印截骨导板辅助手术，对照组15例行常规手术。对比两组患者以下指标：截骨时间、透视次数、术中及术后24 h出血量，术前及术后3个月胫股解剖角、胫骨近端内侧解剖角、胫骨平台后倾角以及计划胫骨平台后倾角矫正角度与实际矫正角度的差值，术前及术后3，24个月KT-2000侧侧差值，术前、术后即刻及术后24个月lachman试验和pivot-shift试验结果，术前及术后3，24个月国际膝关节评分委员会评分及Lysholm评分。

结果与结论：①试验组截骨时间、透视次数、术中及术后24 h出血量均少于对照组，差异有显著性意义(P < 0.05)；②两组患者术后胫骨平台后倾角较术前明显减小，术后胫股解剖角、胫骨近端内侧解剖角与术前无明显变化；试验组术前胫骨平台后倾角计划度数与术后实际度数的差值(0.64±0.41)°较对照组(2.18±0.54)°小，差异有显著性意义(P < 0.001)；③两组患者术后KT-2000侧侧差值与术前相比显著减少(P < 0.05)；术后3，24个月，试验组术后KT-2000侧侧差值与对照组相比无显著差异(P > 0.05)；两组患者术后即刻、术后3，24个月lachman试验和pivot-shift试验均为阴性；④两组患者术后国际膝关节评分委员会评分和Lysholm评分与术前相比显著增加(P < 0.05)；术后3个月，试验组国际膝关节评分委员会评分和Lysholm评分显著高于对照组(P < 0.05)；术后24个月，试验组国际膝关节评分委员会评分和Lysholm评分与对照组相比无显著差异(P > 0.05)；⑤结果表明3D打印精确化截骨导板辅助使胫骨前方闭合截骨更易操作，手术时间更短，透视次数更少，术中及术后失血量更少，术后膝关节功能恢复更快，具有较高的临床应用价值。

https://orcid.org/0009-0002-6550-5088 (魏志亨) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 3D打印, 精确化截骨导板, 胫骨前方闭合截骨术, 前交叉韧带翻修, 越顶位, 数字化骨科

Abstract: BACKGROUND: For patients with anterior cruciate ligament re-rupture after reconstruction with abnormally increased posterior slope of the tibial plateau, anterior cruciate ligament reconstruction combined with anterior closing-wedge high tibial osteotomy was performed. However, there is a lack of precise tools for osteotomy. 
OBJECTIVE: To investigate the effectiveness of three-dimensional (3D) printed accurate osteotomy template in anterior cruciate ligament revision for patients with excessive posterior slope. 
METHODS: The medical records of 30 patients who underwent anterior cruciate ligament revision combined with anterior closing-wedge high tibial osteotomy were retrospectively collected and divided into two groups according to the operation method. The trial group (n=15) was assisted by 3D printing osteotomy guide plate. The control group (n=15) was conventional surgery. The osteotomy time, fluoroscopy times, intraoperative and 24 hours postoperative blood loss, preoperative and 3 months postoperative tibiofemoral anatomical angle, medial proximal tibial anatomical angle, posterior slope, the difference between planned posterior slope correction angle and actual correction angle, and KT-2000 side-to-side difference before operation, 3 and 24 months after operation were compared between the two groups. Lachman test and Pivot shift test were performed before operation, immediately after operation, and 24 months after operation. International Knee Documentation Committee score and Lysholm score were performed before operation, 3 and 24 months after operation.
RESULTS AND CONCLUSION: (1) The osteotomy time, fluoroscopy times, and blood loss during operation and 24 hours after operation in the trial group were significantly less than those in the control group (P < 0.05). (2) The posterior slope of the two groups decreased significantly after operation. There was no significant change in tibiofemoral anatomical angle and medial proximal tibial anatomical angle after operation. The difference between preoperative planned and postoperative actual posterior slope degree in the trial group (0.64±0.41)° was smaller than that in the control group (2.18±0.54)°, and the difference was statistically significant (P < 0.001). (3) The KT-2000 side-to-side difference was significantly reduced in both groups after surgery (P < 0.05). At 3 and 24 months after operation, there was no significant difference in KT-2000 side-to-side difference between the two groups (P > 0.05). The Lachman test and Pivot shift test of the two groups were negative immediately after operation, 3 and 24 months after operation. (4) The International Knee Documentation Committee and Lysholm scores of the two groups increased significantly after surgery (P < 0.05). At 3 months after operation, the International Knee Documentation Committee score and Lysholm score of the trial group were significantly higher than those of the control group (P < 0.05). At 24 months after operation, there was no significant difference in International Knee Documentation Committee score and Lysholm score between the two groups (P > 0.05). (5) In conclusion, with the assistance of 3D printing accurate osteotomy guide plate, anterior cruciate ligament reconstruction combined with anterior closing-wedge high tibial osteotomy is easier to operate, with shorter operation time, fewer fluoroscopy times, less intraoperative and postoperative blood loss, and faster recovery of knee joint function after operation, which has high clinical application value.

Key words: 3D printing, accurate osteotomy guide plate, closed anterior tibial osteotomy, anterior cruciate ligament revision, over-the-top, digital orthopedics

中图分类号: